Extractable fragment versus dusting during ureteroscopic laser lithotripsy in children: Prospective randomized study

Fahmy, Ahmed; Youssif, Mohamed; Rhashad, Hazem; Orabi, Samir; Mokless, Ibrahim

doi:10.1016/j.jpurol.2016.04.037

Cited by 21 publications

(9 citation statements)

References 11 publications

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“…However, this will need to be balanced with the SFR of fragmentation and retrieval technique which seems to be superior [5, 11]. Conversely, a lower operative time and slightly higher SFR were seen with basketing technique in a pediatric study of 100 patients using semi-rigid ureteroscopy [12].…”

Section: Discussionmentioning

confidence: 99%

Role of ‘dusting and pop-dusting’ using a high-powered (100 W) laser machine in the treatment of large stones (≥ 15 mm): prospective outcomes over 16 months

et al. 2018

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Ureteroscopy and laser stone fragmentation (URSL) has had recent advancements with the more powerful laser systems with the ability to 'dust' and 'pop-dust' the stone. We wanted to look at the outcomes of this method for large stones (≥ 15 mm) using our new 100 W holmium laser. Over a period of 16 months (January 2017-April 2018), 50 patients underwent URSL for minimum cumulative stone size of ≥ 15 mm. Data were collected prospectively on patient and stone demographics and outcomes of URSL. The laser setting used was a power of 0.3-0.6 J and a frequency of 20-50 Hz using a long-pulse setting with a 272-µm fiber. Fifty patients underwent 55 URSL procedures (5 bilateral procedures) using dusting and pop-dusting settings. The mean age was 58 years (range 2-88 years) with a male:female ratio of 35:15. The mean single and overall stone size were 10.3 mm (3-23 mm) and 21 mm (range 15-52 mm) with two-thirds of all patients (65%) having multiple stones. The stone location was in the kidney (n = 65, 78%), in the ureter (n = 19, 22%) and 5 patients had bilateral renal stones. With a mean operating time of 51 min, the initial and final SFR were 93 and 98%, respectively. A pre-operative stent, access sheath and a post-operative stent were present in 29 (53%), 34 (62%) and 51 (93%) procedures, respectively. Over a mean hospital stay of 0.6 days (74% day-case procedures), there was one Clavien IV complication related to urosepsis but without any other major or minor complications. Dusting and pop-dusting techniques achieve an excellent SFR with low risk of complications even for large stones. This might set a new benchmark for treating large stones, bilateral or multiple stones in a single setting, without the need for secondary procedures in most cases.

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Section: Discussionmentioning

confidence: 99%

Role of ‘dusting and pop-dusting’ using a high-powered (100 W) laser machine in the treatment of large stones (≥ 15 mm): prospective outcomes over 16 months

et al. 2018

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“…One hundred children (age 1-15 years) with symptomatic ureteral stones were prospectively randomized to one of two groups: dusting (n = 50) or basketing (n = 50). 25 Laser settings utilized for dusting were 0.5 J and 12-15 Hz, while those used for fragmentation with subsequent basket retrieval were 1-1.5 J and 8-10 Hz. Stone free was assessed by US and KUB 1 week following the procedure and defined as absence of any stone fragments.…”

Section: Comparison Studiesmentioning

confidence: 99%

Ureteroscopic Laser Lithotripsy: A Review of Dusting vs Fragmentation with Extraction

Matlaga

Chew

Eisner

et al. 2018

Journal of Endourology

110

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Both dusting and fragmentation with extraction approaches to ureteroscopic stone treatment are effective. In fact, there is little evidence that one approach is better than the other. However, each does have relative advantages and disadvantages, which should be considered. Although dusting tends to be associated with shorter procedure times and a lower risk of ureteral damage, this approach may place the patient at increased risk for future stone events should all of the resultant debris not be expelled from the collecting system. The active removal associated with fragmentation with extraction, in contrast, may provide for a more complete initial stone clearance.

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“…While the number of laser lithotripsy modes used for ablation of urinary stones has proliferated in recent years, in general, there are at least three major techniques that are used, including “dusting” [ 28 – 33 ] (low pulse energy, high pulse rate) to particles typically defined as less than 1 mm in size, “fragmentation” [ 31 , 32 ] (high pulse energy and low pulse rate) with subsequent basketing of larger stone fragments (> 2 mm), and “popcorning” [ 34 – 38 ] where the fiber is held fixed in place and high pulse energy is used to create turbulent flow and break down multiple small stones trapped within a calyx in the kidney, when basketing of multiple stones is not judged to be feasible or efficient. Combinations of these operation modes (e.g.…”

Section: Holmium:yag Laser Lithotripsy (λ = 2120 Nm)mentioning

confidence: 99%

Recent advances in infrared laser lithotripsy [Invited]

Fried

2018

Biomed. Opt. Express

121

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The flashlamp-pumped, solid-state, pulsed, mid-infrared, holmium:YAG laser (λ = 2120 nm) has been the clinical gold standard laser for lithotripsy for over the past two decades. However, while the holmium laser is the dominant laser technology in ureteroscopy because it efficiently ablates all urinary stone types, this mature laser technology has several fundamental limitations. Alternative, mid-IR laser technologies, including a thulium fiber laser (λ = 1908 and 1940 nm), a thulium:YAG laser (λ = 2010 nm), and an erbium:YAG laser (λ = 2940 nm) have also been explored for lithotripsy. The capabilities and limitations of these mid-IR lasers are reviewed in the context of the quest for an ideal laser lithotripsy system capable of providing both rapid and safe ablation of urinary stones.

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Extractable fragment versus dusting during ureteroscopic laser lithotripsy in children: Prospective randomized study

Cited by 21 publications

References 11 publications

Role of ‘dusting and pop-dusting’ using a high-powered (100 W) laser machine in the treatment of large stones (≥ 15 mm): prospective outcomes over 16 months

Role of ‘dusting and pop-dusting’ using a high-powered (100 W) laser machine in the treatment of large stones (≥ 15 mm): prospective outcomes over 16 months

Ureteroscopic Laser Lithotripsy: A Review of Dusting vs Fragmentation with Extraction

Recent advances in infrared laser lithotripsy [Invited]

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